"You may think that the consultants are great, and they know everything, but they don't": exploring how new emergency medicine consultants experience uncertainty.

BACKGROUND: Uncertainty is particularly obvious in emergency medicine (EM) due to the characteristics of the patient cohort, time constraints, and busy environment. Periods of transition are thought to add to uncertainty. Managing uncertainty is recognised as a key ability for medical practice, but is often not addressed explicitly. This study explored how new consultants in EM experience uncertainty, with the aim of making explicit what is often hidden and potentially informing support for doctors to manage the uncertainty they face. METHODS: This was a qualitative study using interpretive phenomenological analysis (IPA). Five consultants working in the UK within one year of achieving a certificate of completion of training were interviewed online during 2021, these were transcribed and analysed using IPA. RESULTS: Three superordinate themes were identified: 'transition and performance as a source of uncertainty', 'uncertainty and decision-making in the context of the emergency department' and 'sharing uncertainty and asking for help'. The transition created uncertainty related to their professional identity that was compounded by a lack of useful feedback. There was tension between perceived expectations of certainty and the recognition of uncertainty in practice. EM doctors were seen as experts in managing uncertainty, with responses to uncertainty including gathering information, sharing uncertainty and seeking help. Expressing uncertainty was viewed as necessary for good patient care but could be risky to credibility, with psychological safety and role modelling behaviour making it easier for the participants to express uncertainty. CONCLUSION: This study highlights the need for new consultants to have psychologically safe, reflective spaces to think through uncertainties with others. This appears to reduce uncertainty, and also act as a source of feedback. The study adds to the existing calls to address uncertainty more explicitly in training, and challenge the expectations of certainty that exist within medicine.

Flipped learning: Turning medical education upside down.

BACKGROUND: Flipped learning is an approach in which core teaching is delivered using online material viewed prior to face-to-face learning, applying knowledge gained from online material. Core teaching in a module for third-year undergraduate medical students was based around a 1-week course comprising 32 hours of lectures. Feedback suggested that students were poorly engaged and attendance was poor. OBJECTIVES: To develop and evaluate a programme of learning for medical students using flipped learning. METHODS: Core lectures were videoed and students were advised to watch online at home in the morning prior to a case-based interactive discussion session in the afternoon. Feedback was undertaken prior to and following change in delivery; changes in Likert scale feedback were assessed. Thematic assessment of free-text feedback was undertaken. Results of in-course assessment examinations were compared prior to and following change in delivery. RESULTS: Student feedback showed a significant improvement in satisfaction with flipped learning compared to standard lectures, both in scores and free-text feedback. Results of in-course assessments did not change between the two methods of delivery. CONCLUSIONS: Flipped learning can improve student satisfaction and engagement with teaching, but our study has not demonstrated an improvement in assessment scores.

Acute mesenteric infarction: an important cause of abdominal pain in ulcerative colitis.

We present four cases of acute mesenteric infarction in patients with active ulcerative colitis: one presenting prior to the diagnosis of ulcerative colitis, two at the time of diagnosis, and one many years after the diagnosis had been made. Intestinal ischaemia is an important part of the differential diagnosis in patients with ulcerative colitis presenting with abdominal pain. Conversely, in patients presenting with bloody diarrhoea after mesenteric ischaemia, ulcerative colitis should be considered.

Applying your clinical skills to students and trainees in academic difficulty.

BACKGROUND: When students and trainees in difficulty present late, there are often signs in their history that suggest that earlier identification and intervention might have been possible. Clinical supervisors may have been reluctant to explore issues with them, perhaps because they felt that it was not their role to do so, or that they may not have the necessary skills or perhaps because of the concern of 'opening a can of worms' that they would not be able to address. INNOVATION: In this article we discuss the importance of early identification and intervention, and draw parallels between the skills required to manage students and trainees in difficulty, and those used daily in identifying and exploring issues with patients. This is based on a combined experience of over 30 years in helping students and trainees in difficulty, and in training and mentoring others to do so. Following this medical model, we highlight straightforward methods for: identifying those in difficulty; making a 'diagnosis'; providing simple interventions; and knowing when and how to refer on. We discuss issues around record keeping, confidentiality and ongoing management, with particular reference to the aspects of the doctor-patient interaction that do not transfer to the supervisor-trainee relationship.

Introduction to teaching for junior doctors 1: opportunities, challenges and good practice.

Doctors are expected to contribute to teaching activities and those who do should develop requisite skills. This two-part article highlights approaches to teaching for doctors in training based on sound educational principles. The first part focuses on identifying teaching opportunities, meeting logistical challenges and implementing good practice.

Introduction to teaching for junior doctors 2: collecting feedback and developing expertise.

Doctors are likely to be involved in teaching activities and need to show evidence of their practice. For junior doctors this means gaining an understanding of educational principles and practice. This second of a two-part article focuses on how to collect feedback on teaching and develop educational expertise immediately and over the longer term.